The importance of words in psychiatry

by TheEditor

Categories: Investigative

Have you ever read a text message and felt your blood boil, only to realise you completely misunderstood the sender? Those baffling moments come from the incredible power words carry — a power that shifts depending on how those words are spoken, the surrounding situation, and who says them. It is like we’re constantly dancing with interpretation, where tone, expression, and your own mood shape the whole experience. Yet, in today’s text-heavy world, much of this vital context gets lost, leading to frequent “did they really mean that?” moments. Let’s explore why our brains play these tricks on us, and how to improve our ability to understand messages clearly, whether they’re spoken or written -and how it relates to clinical practice.

Words in practice

In psychiatry we use a lot of words. The speciality is about talking – we talk a whole lot to other workers, remote stakeholders, and most importantly with patients. We are constantly transmitting in and receiving meanings through spoken words. We speak on the phone, video-conferencing apps, and in live conversations in other people’s actual presence. We write a whole lot for the purposes of creating reports, assessments, documenting in our records, sending emails, and text-messages.

Words are part of language and they are meant to carry meaning. Words are part of language and meant to carry meaning. But language is more than just words. We communicate through language comprised of words but a lot goes into the non-verbal aspects of how we manage those words.

Language as a complex toolkit: Words are indeed the raw material for conveying meaning in language. They’re the building blocks that allow us to form sentences and articulate thoughts. However, it is crucial to acknowledge that language itself is a larger system of expression than just the vocabulary we use. This includes everything from grammar and syntax (how we structure sentences), to more subtle factors like cultural slang and shared references, which provide shared context.

The significance of non-verbal communication: Facial expressions, body language, gestures, eye contact – these add essential layers of meaning that words alone cannot express. They reveal emotion, sincerity, and intention. Nonverbal cues influence how words are received. A statement said while smiling comes across differently than one said with a frown. Even the space we maintain between ourselves and others communicates attitudes, power dynamics, and comfort levels.

Voice as part of the package: Tone of voice, pace, inflection, volume – these are part of the nonverbal aspect of spoken language. They change the impact of words by hinting at sarcasm, excitement, or uncertainty. Even in text-based communication, where spoken voice is absent, attempts to mimic its effects are common: Capitalization for YELLING, drawn-out vowels for boredom, etc. This speaks to the innate human reliance on these expressive components.

Truly understanding what someone wants to communicate means paying attention to not only their word choice but also how they present those words. Mistaking language for only words leads to misinterpretations. We may get hung up on dictionary definitions while missing the vital emotional context surrounding them. Being a keen observer of nonverbal cues can enrich our understanding of a speaker’s message and minimise misunderstandings.

Overview of factors influencing meaning and interpretation of words

Factors Shaping Interpretation

  1. Delivery: How words are spoken carry just as much – and maybe even more – weight as the words themselves.
    1. Tone of Voice: Is it playful, serious, angry, or dismissive?
    2. Pace and Emphasis: Where the stress is placed in a sentence or how quickly it is spoken alters intent.
    3. Volume: Loudness indicates urgency or aggression, softness can imply intimacy or hesitation.
  2. Nonverbal Cues: Words are supported by a vast language of body and facial signals.
    1. Facial Expressions: A smile, frown, glare, or raised eyebrow instantly adds a layer of meaning.
    2. Body Language: Posture, proximity, and even gestures subtly alter how spoken words are perceived.
  3. Context is Crucial: The full picture around a phrase determines its true meaning.
    1. Situational Context: The occasion, physical setting, and events leading up to an utterance matter.
    2. Relational Context: Who is speaking to whom and their familiarity/power dynamics impact interpretation.
    3. Cultural Context: Social norms and shared understandings differ, shaping how we understand words.
  4. Individual Subjectivity: We don’t interpret words neutrally – our own experiences and state of mind colour the process.
    1. Personal Biases: Past experiences with similar words or phrases influence our expectations.
    2. Emotional State: Whether we’re stressed, tired, or carefree impacts how open we are to nuance.
    3. Knowledge of the Speaker: Familiarity with someone’s communication style, or lack thereof, guides understanding.

Challenges for Text-Based Communication

  1. Loss of Richness: Messages lose most delivery, nonverbal, and immediate contextual cues.
  2. Interpretation Left to the Receiver: Without supporting elements, the written word requires the reader to “fill in the blanks”, prone to misinterpretation.

Tips for Accurate Interpretation

  1. Avoid Assumptions: Acknowledge that multiple meanings may be present without further information.
  2. Seek Clarification: Asking directly about intent in an open, neutral way minimises escalation.
  3. Beware of Projection: Be mindful of our own internal state when trying to derive meaning.
  4. Opt for Richer Mediums: If the possibility exists, elevate a text exchange to voice or video, especially for important or ambiguous topics.

Pitfalls of interpreting text-based words

Pitfall 1: The Absence of Tone and Nuance

  1. Words on a screen are flat. We miss the inflection that carries a huge portion of emotional intent. Consider how differently “Okay.” can be interpreted based on delivery: A rising tone suggests a question, a drawn-out syllable boredom, a clipped delivery disapproval.
  2. Without tone, sarcasm, subtle humor, or sincere concern are nearly impossible to distinguish in text. This breeds misunderstanding, especially if you’re not familiar with the sender’s usual communication style.

Pitfall 2: Filling in the Blanks with Our Own Baggage

  1. Text provides the framework; our minds supply the emotional colouring. If we’re stressed or had a negative experience related to the topic, those feelings project onto neutral words.
  2. An innocuous “Are you coming?” may feel accusatory to someone anxiously awaiting a delayed arrival when it would seem casual in any other context.
  3. This lack of nuance makes it difficult to give people the benefit of the doubt within text-based conversations, escalating tensions quickly.

Pitfall 3: Over-Reliance on Emojis and Punctuation

  1. Using exclamation points or smiley faces sometimes conveys intent, but it is imperfect. Exaggerated punctuation in certain contexts can seem passive-aggressive.
  2. Emojis are similarly open to interpretation – depending on cultural background and usage habits, the same emoji may communicate wildly different things to different people.

Avoiding complicatons

  1. Assume positive intent until given concrete cause for concern.
  2. Ask for clarification: “Just to be sure, do you mean X or Y?” goes a long way.
  3. Match the medium to the message: Sensitive or complex topics deserve a live conversation whenever possible.

Pitfalls of interpreting voice-only words

These can happen when speaking over a telephone.

Pitfall 1: Missing the Facial Feedback Loop

  1. Subtle shifts in expression often reveal true nuances of feeling. Over the phone, you miss a raised eyebrow suggesting skepticism, a smile that betrays amusement, or a sudden widening of the eyes denoting surprise.
  2. Much like in text, sarcasm, humor, and gentle teasing can be hard to discern without seeing a person’s face. You lose an important safety net that helps you gauge whether something is playful or not.

Pitfall 2: Voice Isn’t Always Reliable

  1. People’s voices fluctuate. If you catch someone at a bad moment or if they’re not talking clearly, their tone might sound unintentionally harsh or dismissive.
  2. External influences that are invisible to you can skew your interpretation. Someone surrounded by distractions may sound abrupt, even if they don’t intend to be curt.
  3. Illnesses, tiredness, or simply the quality of the connection can lead to a muffled or tonally distorted voice masking sincere emotions.

Pitfall 3: Heightened Sensitivity to Ambiguity

  1. Without the aid of visual cues, we tend to become extra vigilant for subtle changes in the pace, pitch, or volume of someone’s voice, seeking to ‘read between the lines’.
  2. A pause after a sentence in conversation gets filled with our own anxieties and assumptions. Was it hesitation or were they simply thinking about what to say next?
  3. This leads to overthinking and potentially misinterpreting small inflections because we crave context that we don’t have access to.

Additional Challenges:

  1. No Body Language to Aid Interpretation: Over the phone, you can’t see if someone’s nodding attentively, fidgeting due to boredom, or has their arms crossed defensively.
  2. Inability to ‘Read the Room’: Phone calls often lack a shared environment. You may have no idea if a third person entered the space influencing the speaker’s tone or word choice.


These pitfalls make voice-only interactions trickier, especially when the topic is nuanced or emotional. There’s a higher chance of missing underlying concerns or misjudging intent without visual information to support your perception.

Potential Mitigators:

  1. Focus Actively on What’s Said: Pay extra attention to the actual words and sentence structure for clearer clues about intent.
  2. Ask Open-Ended Questions: “Can you tell me more about that?” encourages elaboration and helps reveal the speaker’s true feelings.
  3. Check in If Unsure: “I wonder if I’m sensing correctly some frustration?” allows for immediate clarification and avoids jumping to conclusions.

Live words seen as spoken

Pitfall 1: Mismatched Signals

  1. Contradiction between words and body language: Someone saying, “I’m fine,” with slumped shoulders and a frown reveals mixed messages, making their true feelings ambiguous.
  2. Discrepancies between tone and facial expressions: A sarcastic remark made with a smile creates an uncomfortable disconnect because the nonverbal cues don’t match the verbal content.

Pitfall 2: Unconscious Bias Plays a Hidden Role

  1. Physical appearance influences snap judgments: We instinctively assign more positive intent to words spoken by people who match our aesthetic preferences or social ideals.
  2. Past experiences or stereotypes colour perception: Negative past interactions with a certain type of person may unfairly prejudice our interpretation of a present conversation.

Pitfall 3: “Microexpressions” – Easy to Miss and Misinterpret

  1. Microexpressions require specialised knowledge to ‘read’: Spotting subtle, fleeting emotional cues takes focused attention and understanding of facial microexpressions.
  2. Mistaking a momentary frown for disapproval is common: Even trained individuals can miss or misinterpret brief flashes of emotion.

Pitfall 4: The Overconfidence Trap

  1. Visual cues create an illusion of complete understanding: Having more information than in text or voice-only communication, we often overestimate our ability to decode intent flawlessly.
  2. Assuming you ‘know’ what someone meant leads to missed nuances: This lack of nuance can create misunderstandings when relying solely on our personal interpretation.

Additional Nuances:

  1. Cultural Differences: Some cultures express emotions through gestures more pronounced than others. Interpreting them incorrectly across cultures leads to major misunderstandings.
  2. Neurodiversity: Individuals with ADHD or Autism Spectrum Disorder may process and express body language differently, and may be more direct in their speech. Expecting and applying neurotypical filters on interaction sets everyone up for miscommunication.


Most complaints in health service tend to be written.

Impact of Words in Written Complaints:

  1. The cold, flat delivery: Written complaints lack the nuance of tone, vocal emphasis, and real-time facial feedback that add context to spoken dialogue. Even well-intentioned complaints risk sounding harsh or accusatory on paper (or online) due to the impersonal language used.
  2. The permanence of the record: Unlike a conversation where you can amend a statement or backtrack, a written complaint becomes a static document. Poorly chosen words or impulsively penned sentences can escalate misinterpretations as there’s no immediate room for clarification.
  3. One-sided narrative: Without a back-and-forth exchange, a written complaint tends to present a single perspective. The recipient of the complaint can only piece together the situation based on the chosen words, with no direct opportunity to question or add context to the complainant’s assertions.

Potential Complications:

  1. Increased hostility: The absence of softening factors found in spoken language can make complaints feel overly combative, leading to defensive reactions from the recipient. This makes effective resolution harder, as efforts may primarily focus on refuting the perception of blame instead of addressing the core issue.
  2. Misinterpretation of intent: Without vocal or facial cues, determining the complainant’s underlying frustration level or emotional state is difficult. What one person meant as a straightforward critique can be read as harsh accusation by another, further fueling misunderstandings.
  3. The influence of word choice: Certain words carry greater emotional weight or implicit blame. While in conversation, tone or gestures might clarify this wasn’t meant as an attack, in writing, these words stand alone, amplifying their negative impact.
  4. Legal repercussions: In extreme cases, poorly worded or overly emotive complaints can become the basis for unfounded accusations of slander or libel. The permanence of the written record becomes an obstacle to a harmonious resolution.

Overall, while written complaints provide a necessary way to register dissatisfaction, it is crucial to be mindful of the unique limitations of this form of communication. Choosing words carefully, focusing on objectively detailing the situation, and leaving room for a constructive response increases the chance of a positive outcome for all involved.

Closing summary

Words, those fundamental building blocks of language, seem deceptively simple at first glance. Yet, through our conversation, we’ve uncovered how complex and nuanced communication truly is. We learned that the impact of a word extends far beyond its definition. The true meaning lies in how it is delivered – the inflection of a voice, the flicker of an expression, or the starkness of a typed-out phrase on a screen. These surrounding elements, or their absence in text-based exchanges, leave room for ambiguity and misjudgment. This becomes glaringly apparent with written complaints, where harsh accusations can easily linger due to the lack of contextual softening and the static nature of the written record. It is often a subconscious process, with our own biases and past experiences blurring the lines between a sender’s intent and how we receive the message.

This knowledge underscores the importance of going beyond the mere surface of words. In text messages, it means not impulsively taking offense, but rather asking for clarification and assuming positive intent whenever possible. When listening to someone speak or engaging face-to-face, it calls for mindful attention to body language and unspoken cues. And with written complaints, it begs for extra prudence. Choosing measured language and presenting verifiable facts over emotional judgments increases the likelihood of reaching a productive resolution. Let’s embrace the challenge and the depth of human communication, knowing that a little extra care opens the door to truly connecting with others.

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